| Periodontal Associates Of South Bend | |
|
1918 Edison Rd South Bend IN 46617-1711 | |
| (574) 287-8900 | |
| Not Available |
| Full Name | Periodontal Associates Of South Bend |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 1918 Edison Rd, South Bend, Indiana |
| Authorized Official Name and Position | Gloria Royer (PRACTICE MANAGER) |
| Authorized Official Contact | 7654479319 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontal Associates Of South Bend 1918 Edison Rd South Bend IN 46617-1711 Ph: (574) 287-8900 | Periodontal Associates Of South Bend 1918 Edison Rd South Bend IN 46617-1711 Ph: (574) 287-8900 |
| NPI Number | 1962078642 |
|---|---|
| Provider Enumeration Date | 06/02/2021 |
| Last Update Date | 06/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962078642 | NPI | - | NPPES |
| 12013130A | Other | IN | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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